Provider Demographics
NPI:1972213460
Name:MORIARTY, RYAN PATRICK (RPH)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:MORIARTY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4614
Mailing Address - Country:US
Mailing Address - Phone:203-710-7798
Mailing Address - Fax:
Practice Address - Street 1:280 BRANFORD RD
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-7000
Practice Address - Country:US
Practice Address - Phone:203-488-8703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist